A second 12-lead ECG performed on a patient 4 hours after the onset of chest pain reveals ST segment elevation. What does the nurse recognize that this finding indicates?

Correct Answer: C

Rationale: In the context of a patient presenting with chest pain and ST segment elevation on a second 12-lead ECG, the correct answer is C) MI associated with prolonged and complete coronary thrombosis. This finding typically indicates an acute myocardial infarction (MI) where there is prolonged and complete blockage of a coronary artery leading to ischemia and subsequent tissue damage. The ST segment elevation seen on the ECG is a key indicator of myocardial injury in the setting of an MI. Option A) Transient ischemia typical of unstable angina is incorrect because unstable angina usually presents with transient ST segment depression or T-wave inversion, not elevation. Option B) Lack of permanent damage to myocardial cells is incorrect because ST segment elevation typically indicates ongoing ischemia and damage to myocardial cells in the setting of an acute MI. Option D) MI associated with transient or incomplete coronary artery occlusion is incorrect because ST segment elevation is more indicative of a complete and prolonged occlusion leading to an MI rather than a transient or incomplete occlusion. Educationally, understanding the significance of ST segment elevation on an ECG in the context of chest pain is crucial for nurses working in cardiovascular care. This knowledge helps in prompt recognition of acute MI and initiation of appropriate interventions to minimize cardiac damage and improve patient outcomes.

Correct Answer: C

Rationale: Buerger's disease, also known as thromboangiitis obliterans, is a rare disease characterized by inflammation and clotting of small and medium-sized arteries and veins in the limbs. The correct answer is C) Both A and B - vascular inflammation and limb ischemia. The vascular inflammation in Buerger's disease leads to the formation of blood clots, which can result in limb ischemia due to reduced blood flow to the extremities. This can cause symptoms such as pain, skin ulcers, and tissue damage in the affected limbs. Option A) Vascular inflammation alone is not sufficient to describe Buerger's disease as limb ischemia is a key feature of the condition. Option B) Limb ischemia alone does not encompass the full spectrum of the disease, as the underlying vascular inflammation is what triggers the ischemic events in Buerger's disease. Option D) None of the above is incorrect as Buerger's disease is indeed characterized by both vascular inflammation and limb ischemia. In an educational context, understanding the characteristics of Buerger's disease is important for healthcare professionals, especially those working in cardiovascular or vascular specialties. Recognizing the signs and symptoms of this disease is crucial for early diagnosis and appropriate management to prevent complications such as tissue loss and amputation. By knowing that Buerger's disease involves both vascular inflammation and limb ischemia, healthcare providers can provide better care and support to patients with this condition.

Correct Answer: B

Rationale: The correct answer is B) blood in the urine. When a patient on heparin infusion develops blood in the urine, it is indicative of a possible complication known as heparin-induced thrombocytopenia (HIT). HIT is a serious immune-mediated reaction to heparin, leading to a decrease in platelet count and an increased risk of thrombosis. This can manifest as blood in the urine due to the formation of blood clots in the urinary tract. Option A) vomiting is unlikely to be the earliest evidence of a heparin infusion complication like HIT. Option C) a drop in prothrombin time would not be an early sign of a heparin-related complication since heparin does not directly affect prothrombin time. Option D) pain in the calf of the leg suggests a possible deep vein thrombosis (DVT) which can be a complication of heparin therapy but is not the earliest sign compared to blood in the urine. In an educational context, understanding the early signs of complications related to heparin therapy is crucial for nurses and healthcare providers to promptly recognize and manage adverse events. Monitoring for subtle changes in the patient's condition can help prevent serious consequences associated with heparin-induced complications.

Correct Answer: D

Rationale: In the context of improving compliance with the medical regimen in hypertensive clients, establishing a relationship with each client (Option D) is the most crucial action for the nurse to take. Building a strong nurse-client relationship fosters trust, open communication, and mutual respect. When clients feel understood, supported, and valued, they are more likely to adhere to their treatment plan, including taking medications as prescribed, following lifestyle recommendations, and attending follow-up appointments. Insisting that clients keep their appointments on time (Option A) is important but may not address the underlying reasons for non-compliance. Explaining the pathophysiology of hypertension (Option B) is informative but may not directly impact compliance if the client does not feel connected to the nurse. Warning clients about side effects of medications (Option C) is necessary but may not address the holistic needs of the client in terms of compliance. Educationally, it is essential for nurses to recognize the significance of forming therapeutic relationships with clients to promote positive health outcomes. By prioritizing the establishment of trust and rapport, nurses can create a supportive environment where clients feel empowered to actively participate in their care, leading to improved adherence to medical regimens and better management of chronic conditions like hypertension.

Correct Answer: D

Rationale: In auscultating Mrs. Payer's lung fields, the correct answer is D) rales. Rales, also known as crackles, are abnormal lung sounds that indicate fluid in the alveoli or airways. In the context of cardiovascular issues, such as heart failure, fluid can accumulate in the lungs leading to the presence of rales upon auscultation. Option A) decreased breath sounds would be more indicative of conditions like pneumothorax or pleural effusion where there is limited air movement in the lungs. Option B) wheezing is typically associated with conditions like asthma or COPD, where there is narrowing of the airways leading to a whistling sound during breathing. Option C) atelectasis refers to collapsed lung tissue and would present as decreased or absent breath sounds in the affected area. Educationally, understanding lung sounds is crucial for nurses and healthcare professionals in assessing respiratory and cardiovascular health. Recognizing the difference between various lung sounds helps in early detection of complications and prompt intervention. In the case of Mrs. Payer, identifying rales could prompt further assessment and management of her cardiovascular condition.